medications as prescribed, not following a low-sodiumdiet or not calling the doctor soon enough when symptomspresent. Hospitalization, especially if it is frequent, is a timefor patients and doctors to identify how the patient can bebetter supported in managing their HF when they aren’tin the hospital. A discussion regarding next steps is oftenneeded — where do we go from here.”Typically, when patients are hospitalized for HF, it isnot the first time they are hearing about the condition.Understanding why they’ve been hospitalized is important.If patients are there because their condition is worsening,then additional evaluation needs to take place. If there is anissue with the plan of care, then their hospital stay is a goodtime to identify the challenges, so that care providers andpatients can work together to find a better process of care.Are financial challenges keeping them from buying theirmedication? Do they have proper support at home? Do theyunderstand what a low-sodium diet is? “It’s really importantwhen patients are hospitalized to help them identify HFself-care strategies and potentially reduce frequent re-hospitalizations,” Grady said.

Grady points out that early follow up after hospitalization,
generally with a phone call from the medical team, helps
ensure patients are taking the right medicines at the right dose
and frequency. Grady likes for patients to make a follow-up
clinic visit shortly after they’ve been discharged to evaluate
how they’re doing. That visit should not only include the
usual physical exam, but also a follow-up discussion on self-care and if the patient is feeling confident about how they’re
managing their HF. “It’s important for HF patients who
have been hospitalized to be seen on a regular basis,” Grady
added. “That can help keep them out of the hospital. It’s even
better when the people helping care for them at home also
participate in the discussion.”

MEDICATION RECONCILIATION

Much HF treatment relies on medication, and that canbe a challenge all by itself. A crucial part of meeting thatchallenge is medication reconciliation. That should happenwhen the patient first comes to the hospital and again beforedischarge. The first step, upon hospital admission, is toidentify the medications the person has been taking as anoutpatient. This is typically done by a nurse who talks withthe patient and family. “It’s best if thatinformation can be double checked withoutpatient medical records, to make surethat a patient is taking everything theirproviders have prescribed and not morethan prescribed,” Grady said.

During hospitalization, there maybe medication changes. Medicationspreviously taken at home may be discontinued. A thoroughdiscussion with both the patient and their caregiver about allthe medications to be taken and any that were stopped needsto happen at discharge. That discussion should include:• what each medication is for,• the correct doses and frequency,• side effects, and• very important — making sure they have access to thosemedications with prescriptions.

“Nurses and pharmacists can be invaluable in doing thatmedication reconciliation with the patient and the familymember,” Grady said.

Follow-up clinic visits should also include medication
reconciliation. This is why patients are often asked to
bring in all their medicines so that the clinic nurses and
doctors can see exactly what the person is taking. “That
is critical to ensure that patients are taking the right
medicines, only those medicines, and none other,” Grady
said. “Of course, it can become really challenging when
they have several conditions, such as diabetes, high
cholesterol and kidney disease, and are taking 10 or more
medications once or twice a day, often prescribed by
different doctors. If there are discrepancies in medication
dosing, patients are encouraged to talk to the doctor
who prescribed the medication. It’s also important for
clinicians to talk to one another, to help the patient with
taking all of the right medications all of the time.”

DISCHARGE

Grady urges patients and caregivers to think of dischargeas a process that begins on the first day in the hospital.Patients and families need to share any problems they arehaving with their healthcare team. It’s better to identify theMany times patients delay callingtheir physician about symptomsfor fear that they will end up inthe hospital.